In the area of cataract surgery, there exists a method of small incision lens removal utilizing ultrasonic energy termed phacoemulsification. This use of a small incision allows more rapid visual recovery for the method but also makes this method technically more difficult, especially with patients with advanced cataracts containing a hard nucleus.
A newer variant of the phacoemulsification method attempts to make removal of harder lens nuclei safer and simpler by fractionating the nucleus into four separate quarters or quadrants before phacoemulsification and aspiration. This method accomplishes fractionation by sculpting two V-shaped crossing grooves into the nucleus to set-off four generally equal sized quadrants. The phacoemulsification instrument is then inserted in the groove to provide a central to peripheral force which is opposed by a similarly placed second instrument positioned in the eye through a separate smaller incision. The two opposing forces result in the splitting of the nucleus into two which are in turn similarly split to yield four quarters. This fractionation technique makes the challenging phacoemulsification part of the procedure safer, but requires the use of two instruments and the added skills needed to manipulate these instruments to split the lens nucleus.
The fractionation technique can be accomplished with one instrument in the form of cross-action forceps manufactured by Rhein Medical of Tampa, Fla. These forceps disadvantageously require a large incision or wound for entrance into the eye and to accomplish fractionation because the arms spread a considerable distance in order to spread the lens cracking paddles. Additionally, these forces require multiple introduction and removals of the phacoemulsification instrument from the eye before complete four quadrant fractionation can occur. The additional instrument introduction and removals place the eye at higher risk for complication, such as iris injury, stripping of descemets membrane and even rupture of the posterior lens caps.